Routine inspection·December 16, 2025

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Annabelle Ablan. During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 5 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring the garage, LPA observed 2 walls constructed with two doors, with storage located inside. Based on a review of the facility sketch, these walls are not reflected on the facility sketch. ADM stated she believes she has a permit, but will have to check since she made the change in the garage. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 118 degrees F in resident bathrooms. Fire extinguisher was serviced in . The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 4, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA reviewed R2's file. LPA noted R2 was admitted into hospice in March 2025. LPA searched CDSS records, but R2's hospice notification form was not in CDSS records. LPA requested a copy, but a copy was not provided. LPA informed ADM that one of the stipulations of the hospice waiver is to notify the department within 5 working days when a resident is receiving hospice services. Deficiencies cited during today's visit, See LIC809-D. This report was reviewed with Administrator Annabelle Ablan and a copy of the signed report was provided. Appeal Rights were provided.